UK drug scene ever more complex and dangerous

The latest UK Street Drug Survey from drug charity DrugScope reveals a worrying picture of vulnerable groups in society using an increasingly diverse range of illegal and legal drugs, while higher street drug purities are fuelling concerns about a rise in drug-related deaths.

DrugScope conducted this snapshot of the UK drug scene during December 2014, interviewing frontline drug workers, service user representatives, police and other drug professionals in seventeen towns and cities across the UK (1).

Pregabalin and gabapentin use widespread among drug users and prisoners

Most of the 17 areas covered by the survey highlighted the significant increase in use of two prescription drugs, pregabalin and gabapentin (2), chiefly among Britain’s opiate-using and prison populations (3). These anticonvulsant medications are increasingly prescribed to treat epilepsy, neuropathic pain and anxiety (4).

People who misuse the drugs do so because of the feelings of euphoria they can create; they are commonly used alongside – and as enhancers to – other drugs, such as alcohol, opiates such as heroin or methadone, and diazepam. Pregabalin and gabapentin are easily available on the illicit market in 25mg to 800mg capsules, changing hands for between 50p and £2.

Drug workers reported users displaying extreme intoxication and uninhibited, risky behaviours while on the drugs. Mixing these medications with other central nervous system depressants such as opiates and alcohol significantly increases the risk of overdose. Deaths involving pregabalin and gabapentin are on the rise (5) and the Office for National Statistics told DrugScope that pregabalin and gabapentin were mentioned on 41 death certificates in 2013 (pregabalin on 33 and gabapentin on 9).

Synthetic cannabinoids causing problems in at-risk groups

Almost every area reported a continued rise in the use of new psychoactive substances; the rapid rise in the use of synthetic cannabinoids such as Black Mamba and Exodus Damnation by vulnerable groups such as opiate users, the street homeless, socially excluded teenagers and by people in prison was of particular concern. One homeless charity in Birmingham described how a large number of their opiate-using clients and street drinkers were smoking synthetic cannabinoids, leading to health emergencies. According to many respondents, synthetic cannabinoids were readily available in prisons and many people referred into services from jails came out with dangerous levels of use of the drugs. These findings support concerns expressed by the Chief Inspector of Prisons Nick Hardwick in his 2013 – 14 annual report, about the use of synthetic cannabinoids within the prison estate (6).

Drug purities increasing in ‘traditional’ drugs

The street level purity of cocaine, ecstasy and heroin had gone up significantly in most areas covered by the survey following several years of high adulteration across the board. Two interlinking factors are thought to be at play: falling wholesale drug prices that have enabled Class A suppliers to improve their product in the face of competition from cheap, yet potent, new psychoactive substances.

The purity of cocaine, ecstasy and heroin has doubled and tripled in the last year in some areas. In Bristol, police said cocaine purity jumped from an average of 10 per cent in 2013 to 30 per cent in 2014, while heroin had risen from an average purity of 10-15 per cent to 20-25 per cent. Police in Liverpool said cocaine had risen from a single figure average to 25 per cent, and heroin from 25 per cent to 40 per cent.

Concerns about rising drug-related deaths

There are significant concerns in the drug and alcohol sector about the rise in drug-related deaths and findings from the DrugScope survey suggest that many of the key risk factors have been accentuated in 2014, including increased drug purities. Data published by the Office for National Statistics (September 2014) (7) revealed that 1,957 drug misuse deaths were registered in 2013, up 20 per cent on the figure for 2012 (1,636) and deaths related to heroin/morphine, the substances most commonly involved in drug poisoning deaths, rose 32 per cent.

Respondents to the survey who had looked into deaths in their area found a mixture of possible causes for the rise, including more heroin users dropping out of services, a downscaling of outreach work, the increasing age of the heroin using population and people overdosing on higher strength heroin. Of the areas that mentioned a rise in drug deaths, some said increased access to naloxone (8) had prevented overdoses becoming fatal.

DrugScope’s Chief Executive, Marcus Roberts, said:

“It is clear that our members working in drug and alcohol treatment services are facing new and more complex challenges, at a time when we are expecting significant cuts to local services in the years ahead. The survey emphasises that treatment providers need the investment and capacity to adapt to changing circumstances and that proper assessment of local needs is vital. Directors of Public Health and other local officials must take the diversity of the 2015 drug scene into account when planning local service provision. National debate on drug policy needs to reflect the changing patterns of drug use, and recognise the risks to individuals and communities, particularly the most vulnerable, and the importance of drug services.

“Sadly, too, our members are concerned that drug-related mortality figures will continue to rise. Speaking to member organisations working on the ground has underlined yet again the importance of more comprehensive availability of take-home naloxone to help combat the rising number of fatalities linked to opiate use. We keenly await the necessary regulatory changes which government sources suggest are due to take place over the course of the next year.

“Coupled with substantial rises in ecstasy deaths and the challenges posed by new psychoactive substances in recent years, there is clearly much work to do in continuing to warn people about the dangers of drug taking. We need to continue to do all we can to reduce the harms that drugs cause.”

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